A foreign body granuloma after gastric perforation mimicking peritoneal dissemination of gastric cancer: Report of a case

Abstract

This report presents the case of a 58-year-old man who was found to have foreign body granulomas (FBGs) that mimicked disseminated gastric cancer. The patient presented with a severe attack of acute upper abdominal pain, was admitted to the hospital, and thereafter underwent an immediate laparotomy due to a diagnosis of an upper gastrointestinal perforation. Follow-up endoscopy revealed an ulcer scar measuring 2 cm in size in the anterior wall of the middle stomach. The pathological examination of biopsy specimens taken around the scar revealed well to poorly differentiated adenocarcinoma. At the time of reoperation performed 2 months after the first operation, many small white granulomas were observed which were thought to be the result of peritoneal dissemination of the gastric cancer. However, both the cytology of the Douglas washing and pathological examination of frozen section specimens were negative for carcinoma, and therefore a distal gastrectomy was performed. The pathological examination revealed the presence of FBGs. In this rare case, the FBGs formed shortly after surgery and were difficult to distinguish from disseminated cancer.

Large gastric ulcer: Result of foreign body-induced giant cell reaction

“…[7][8][9] The search of the English literature revealed a case report on foreign body granuloma in peritoneum mimicking disseminated gastric cancer. [10] Granuloma of the peritoneum induced by activated charcoal from intraperitoneal chemotherapy in a patient with gastric ulcer, which mimicked peritoneal metastasis, has also been reported. [11] Food starch granuloma of the appendix and peritoneum after perforation of gastric ulcer has also been reported.…”

“…[16,17] Most of the case reports show that the granulomas of the stomach were diagnosed after gastric resection procedures. [10,18] A few other reports have suggested causal role of H. pylori infection in the pathogenesis of granulomas. [19]…”

Foreign body granulomas mimic peritoneal dissemination caused by incarcerated femoral hernia perforation: A case report

“…IFBGs associated with lycopodium, talcum, and starch powders from surgical gloves have previously been reported, and these IFBGs can be quite difficult to differentiate from cancerous nodules[ 7 , 9 , 10 ]. Akita et al [ 5 ] reported that food starch released from gastrointestinal perforations could cause multiple IFBGs, mimicking peritoneal dissemination; they reported a case in which tenderness and guarding over the entire abdomen was observed due to a gastric cancer perforation, which was treated surgically. Two months later, many small, white granulomas mimicking peritoneal dissemination were observed, particularly in the upper abdominal cavity, which were diagnosed as IFBGs based on frozen sections during the second operation.…”

“…However, in rare cases, bowel perforation, bile or gallstone spillage, and foreign bodies unrelated to operations, such as fish bones, can result in IFBGs[ 4 - 6 ]. Furthermore, IFBGs sometimes occur multifocally and can closely resemble peritoneal dissemination, leading to misdiagnosis[ 5 , 7 ]. Here, we present a case of IFBGs mimicking peritoneal dissemination 4 mo after an operation to treat an incarcerated and perforated femoral hernia.…”

Efferent Loop Syndrome in a Post-pancreatoduodenectomy Patient Due to Exuberant Foreign Body Giant Cell Reaction Mimicking Cancer: A Case Report

“…As pancreatoduodenectomy is a major undertaking fraught with major complications, we feel it is unfortunate that our patient underwent this procedure because of a mass that was later discovered to be due to FBGCR. However, FBGCR has been reported to be the cause of formation of masses that were mistaken for malignant deposits [7-10]. These masses have even led to surgical resection of the suspected areas [8,10].…”